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MWCC WORKERS COMPENSATION FIRST REPORT OF INJURY OR ILLNESS EMPLOYER (NAME & ADDRESS INCL ZIP)CARRIER/ADMINISTRATOR CLAIM NUMBEREnter Actual School Location HereJURISDICTIONREPORT PURPOSE CODEJURISDICTION
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How to fill out mwcc-workers compensation-first report of

01
Obtain the MWCC Workers Compensation-First Report of form from your employer or the workers' compensation department.
02
Fill out your personal information including name, address, and contact details.
03
Provide details of the incident including the date, time, and location of the injury.
04
Describe the nature of the injury and how it occurred.
05
Include information about any medical treatment you have received for the injury.
06
Sign and date the form before submitting it to the appropriate party.

Who needs mwcc-workers compensation-first report of?

01
Employees who have been injured on the job and are seeking workers' compensation benefits.
02
Employers who are required to report workplace injuries to the MWCC for record-keeping purposes.
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The mwcc-workers compensation-first report is the initial report filed by an employer when an employee is injured on the job and a workers' compensation claim is initiated.
Employers are required to file the mwcc-workers compensation-first report when an employee suffers a work-related injury.
The mwcc-workers compensation-first report should be filled out by providing details of the employee's injury, including the date, time, and location of the incident.
The purpose of the mwcc-workers compensation-first report is to document the details of a work-related injury and initiate the workers' compensation claim process.
The mwcc-workers compensation-first report must include details such as the employee's name, date of birth, job title, description of the injury, and any medical treatment received.
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